Education  |   September 2018
Endotracheal Tube Obstruction Caused by Cuff Hyperinflation
Author Notes
  • From the Department of Otolaryngology (J.Z., D.G., J.D.R.) and Department of Anesthesiology (I.C.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Zenga: Joseph_Zenga@meei.harvard.edu
Article Information
Education / Images in Anesthesiology / Airway Management / Technology / Equipment / Monitoring
Education   |   September 2018
Endotracheal Tube Obstruction Caused by Cuff Hyperinflation
Anesthesiology 9 2018, Vol.129, 581. doi:10.1097/ALN.0000000000002233
Anesthesiology 9 2018, Vol.129, 581. doi:10.1097/ALN.0000000000002233
WHILE endotracheal tube obstruction by the air cuff is rare, it is not a new phenomenon. As early as 1957, cuff hyperinflation was a reported cause of ventilation failure, leading to several deaths.1  Most commonly, airway obstruction results from herniation of the thin pliable cuff plastic, either into the lumen of or around the end of the endotracheal tube (Images A and B, in vivo deflated and hyperinflated; video, Supplemental Digital Content 1, http://links.lww.com/ALN/B706, and 2, http://links.lww.com/ALN/B707, which demonstrate distal obstruction by the air cuff in vivo and ex vivo, respectively). These herniation events may be even more likely in the presence of nitrous oxide, due to diffusion of the gas into the closed space of the cuff.2  To avoid hyperinflation, an excessive volume of air in the endotracheal cuff should be avoided. The clinician may periodically auscultate the neck to determine the minimum cuff inflation volume at which the inspiratory air leak disappears.
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